Double Jaw Surgery

Nothing cute about it.

After ten grueling years of waiting for all of the stars to align (more about this later), I finally had my much needed double jaw surgery, for my class III malocclusion.

In real talk, here is what was going on:

I had slightly misaligned teeth, from the time I was about 7 years old, and began getting in my adult teeth.

This started with just the bottom front teeth, which my parents assured me would eventually straighten out.

Long story short, straighten out they did not.

With each new lost tooth, a new misaligned one grew in, due to what we didn’t realize at the time, was because my jaws were not growing in sync with my teeth.

Turns out, this would have been a simple fix of a palate expander that cost about $50 in a dentist’s office, but hindsight is 20/20.

Now in my teens, I had a mouth full of straight-ish top teeth, and not so straight bottom teeth, which weren’t bad enough looking that orthodontia seemed imperative, but were silently creating a huge array of other issues, from sleep apnea, bruxism (grinding), and TMJ.

My small jaws meant I had a very small air passageway, and this combined with a deviated septum from baseball related nose injuries, left me nearly incapable of breathing with just the slightest bit of congestion.

Any sort of athletic pursuit had me completely winded, as I was never able to inhale enough oxygen. I loved swim and track, but I was always left gasping for air, regardless of how much conditioning I put in.

I never knew what it was like to sleep with my mouth closed, as I relied entirely on keeping it open to breathe at night, something I assumed was due in whole to my nose injuries. Miraculously, I have never been a snorer, but chronically I would wake with parched lips.

By age 15, I had begun to research my dental issues from a purely cosmetic standpoint, as I had already started dating, and felt insecure with my smile. To this day, I don’t think I have a single photo of myself anywhere, smiling with my teeth visible.

Facebook was fairly new at this time, and I was as much as anyone, and enthusiastic over-sharer of selfies. Family and peers began to ask me why I never took photos smiling, which made me self-conscious and defensive.

By the time I was 17 years old, I knew definitively, not just from my own research, but also from the fact that my mouth was too small to accommodate my incoming wisdom teeth, that I was going to not only need to have them removed and get braces, but that I was also going to need double-jaw surgery.

Being in this position is difficult as a teenager, when you’re unable to fully explain or convince family as to what the nature of your issues and daily quality of life was. Eating was challenging; only one side of my mouth had teeth that made full contact, so that was the only side I was able to use. Biting into an apple was something I didn’t even dare attempt.

Due to my limited masticating ability, I was almost always swallowing my food without chewing it, which then led to digestive issues…

And so the saga went on.

The delay in correcting this huge problem was multifaceted:

1. The surgery was extremely expensive (roughly $40k-$60k), and was outside of what my family could afford to cover, as we did not have health or dental insurance at the time
2. Appearance wise to family and friends, nothing looked ‘bad enough’ to warrant something as drastic as an operation with many risks of complications
3. Finding someone competent to perform the operation was also a challenge, as every opinion given was different

Botox treatment begins

At age 23, after several years of researching potential solutions for my now debilitating migraines from the TMJ I had developed, I found Dr. Alexander Rivkin, who pioneered a treatment using high doses of Botox®, injected into the temporalis and masseter muscles, temporarily paralyzing them, and training them not to be in an constant state of contracting.

My TMJ had started to take over my life; I hated eating in front of other people because of the constant clicking and popping when I would open my mouth, I didn’t want to socialize, work was difficult, and more often than not, the majority of my days would be spent simply putting as much pressure as I could on my jaw and temples, in a pool of my own tears, due to the severity of the migraines.

The Botox® treatments from Dr. Rivkin were life changing. For anywhere from 1 – 3 months, I had complete relief from the migraines and other symptoms.

And for the past 5 years, I’ve faithfully had these $2,500 – $2,700 treatments done, every 3 months, the last time having been just a few weeks ago, when I was in Beverly Hills.

But, in addition to being expensive, they are only a temporary fix on me, due to the root of my TMJ being skeletal, rather than muscular. For some lucky people, only one or two rounds of this treatment is required for permanently life changing results.

After the first year and several treatments later, I knew that I was not going to be able to rely on this forever, and it was time to pull the trigger on having the surgery.

At 23 I had braces put on, which was humbling in of itself. Most of my friends and peers had finished this stage of their lives by the time they were 17—right about the time I realized this needed to be done in the first place.

I went to the same clinic I had used to have my wisdom teeth removed, thinking perhaps it would solve my dental overcrowding, and was from there referred to my orthodontist, Dr. Lambourne, who has been a gem this entire process.

This began the now 5 year journey I’ve been on in preparation for oral surgery…

The first surgeon I met with told me he didn’t think I should have the operation at all, and in his words, “it isn’t really all that bad”, which felt like insult to injury.

Next.

I specifically sought out another oral surgeon at the same clinic, who specializes in TMJ, to evaluate and perform my operation. He agreed to perform the operation, and explained his detailed plan on how to correct my bite and asymmetry.

For 3 years we worked together, nightmare after nightmare of insurance denial delaying the surgery date.

I waited months to hear back from their office on insurance approval status, often feeling like I had been pushed to the bottom of the list, which turns out, wasn’t far from the truth.

Frustration after frustration, I finally decided to take matters into my own hands and press for a face-to-face meeting with my surgeon, who to my utter dismay, explained to me that he only felt comfortable operating on my maxilla (upper jaw), to which he’d been able to secure a 20 day window of approval from my insurance to operate, and then proceeded to tell me that either I could go ahead and schedule to have him operate on my upper jaw only, during this timeframe, or he wouldn’t be performing the operation at all, in which case, the insurance approval process would have to be completely re-started, which was not likely to be approved after having had so many previous denials.

He suggested that I should seek a different opinion from two different surgeons at a clinic across town.

I made the appointment, and went to the consultation.

The consultation took place with two doctors, who owned the clinic. One of the doctors I met with tried to talk me out of having the operation on my lower jaw, and only proceeding with the upper, as had my previous surgeon. The second doctor, who specialized in cosmetic oral surgery, was of the opinion that I should have the both done.

Let me continue this by stating, my lower jaw had been the most bothersome of the two to me, but I had been adamant the entire process that I needed both of them done.

I will also state that I’m aware it sounds insane to assume that I know more than a doctor would know about the best route to proceed in, but I had been living with this for over a decade already, maybe two, and in all of that time, had become very well acquainted with my own features, issues, asymmetries and imbalances.

I finally felt validated, as someone was willing to listen to what I was telling them, meticulously look over my x-rays, evaluate the measurements, analyze the damage done to my temporal-mandibular joint, and reassure me that I was not the only one that could see what was wrong.

However, because these two doctors were partners, performed all surgeries in tandem, and could not agree on how to proceed, they referred me to yet another surgeon, this time on the opposite side of the state, in Missoula, Montana.

I did not want to drive all the way across the state for a consultation, let me begin by saying that, so I delayed for several months, before realizing my approval window for surgery had expired, and then I began to panic.

During this time, assuming insurance was never going to cover my operation, I found a extremely reputable and highly regarded oral surgeon in South Korea, and had begun to make arrangements to have my operation there, both jaws, as when they evaluated my x-rays, they immediately came to the unanimous conclusion that would be my only route to actual, complete correction and relief.

But, somehow, everything seemed to have worked the way it did for a reason, because by this point, it was now around June, 2018.

I had gone back to Beverly Hills, had received another round of Botox® injections from Dr. Rivkin, and had met with a few other doctors in Beverly Hills, and was even referred to a specialist in oral surgeries, out of Santa Barbara.

My sister and I were already making plans for South Korea, but for whatever reason, I couldn’t shake the feeling that I needed to at least go to a consultation with the doctor in Missoula.

I was nervous, because I like to research everything obsessively before committing, and there wasn’t much I could find on this doctor, or his clinic, but my family encouraged me to go, and see where things went.

From the moment Dr. Taylor walked into the room, I knew I had finally, finally come to the right place.

For once, someone was talking to me directly, not speaking as if I couldn’t understand.

Dr. Taylor was no-nonsense, assertive, and extremely reassuring.

He asked me about my previous surgical plans, and why I had elected to only have the upper jaw corrected, to which I explained that was not my choice, but rather the previous surgeon’s recommendation.

Shaking his head, he said, “No, absolutely not. You need both done, they are doing it all wrong, and I’m going to show you why.”

After his detailed explanation of how he intended to go about my operation, I felt a wave of complete relief, for the first time since I had begun this long, long nightmare.

“So, I’m not crazy and just imagining things?”
“No, you’re not crazy. Anyone who can’t see this is blind, or under qualified…”

That was it. This was where I was going to have my surgery, and immediately I switched over as his patient.

I expressed some concern about getting insurance approval, since it had been rejected so many times, but Kathy, his treatment coordinator assured me saying, “Dr. Taylor is really good at getting these things taken care of. You don’t need to worry about that.”

He sent me back home with instructions for my orthodontist to reverse some of the movement in my teeth that had been directed by my previous surgeon, allowing for a less invasive operation with less cuts, and better results.

Within 2-3 months, everything was lined up and ready to go. I took what would be the last of my pre-op photos, x-rays and models, and waited.

Sure enough, just like they had told me, I received full insurance approval

During all of this time, I had also been working on opening my business, and our opening date was barely 2 months before my original surgery date, which was set to be the 12th of February.

I was relieved when we ended up pushing it off two weeks, as it gave me more time to get my employees and sister comfortable without my being there for what will most likely end up being close to 6 weeks, if not longer.

Thursday, February 28th, 2019, I finally had my surgery.

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“Everything went very, very well.” Dr. Taylor assured me with a smile.

Somewhere through the swelling, I was crying happy tears.

I can’t even begin to explain how emotionally and physically draining this journey has been. Not to say that it’s over, because I am merely on day 4 of recovery, and am more swollen than I imagined possible, I am irritable from the discomfort, weak from my lack of appetite and inability to consume food other than liquids, dehydrated, cracked lips, bored out of my mind, and an emotional ball of nerves… but!

I finally made it here, and I am scared and excited to see what comes next, past recovery.

I’m not even certain what my face will look like when the swelling dissipates, so that will be a whole thing in of itself.

In the meantime though, re-living this process in my head, the years of pain and then the emotional turmoil I went through to get here… I am left without the proper words to describe how I’m feeling.

I suppose only time will really tell.